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Vitamin B12 deficiency Having trouble absorbing vitamin B12 from food, lacking intrinsic factors (for example, as a result of pernicious anaemia), having gastrointestinal surgery, taking certain medications for an extended period of time (such as metformin or proton pump inhibitors), and nutritional deficiencies are all causes of vitamin B12 deficiency

[51] During clinical trials, the common side effects affecting more than one in 10 people are (in order of frequency): pain and swelling at the injection site, tiredness, headache, muscle aches, chills, joint pain, fever or diarrhea

This mostly occurs at the para position via the formation of an epoxide intermediate

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Bottom line Metformin and insulin are key medications for glycemic control, but they work in different ways and serve different purposes